Honduras June 2016: VCU Global Health and Health Disparities Trip Summary

Since 2005, we have been collaborating with the local leaders and the Ministry of Health in Departamento Yoro, Honduras.

Here is a brief summary of the 2016 trip.

Day 1, June 20, 2016:

Olanchito, Honduras, we arose early and packed up the pick up trucks. We headed out of
the city, up the mountain, to La HIcaca.  The first ½ day of clinic was uneventful with 61 adult patients seen from aldea (community) La Hicaca.

Day 2, June 21, 2016:

First full day of clinic hot and humid. Patients were seen from aldeas Crucete, La Florida, Agua Caliente and Puerto Rico at a steady pace until 5 PM. Apart from the common ailments, one case of very poorly controlled, newly diagnosed diabetes with severe dehydration requiring IV fluid in our clinic.

In the Copa America semifinal, Argentina beat the USA 4-0 and we listened intently over the AM radio airwaves.

Day 3, June 22, 2016:

Off to Lomitas, a very remote area with a crowded, makeshift clinic where we saw 100 adult patients and approximately the same number of pediatric patients from aldeas Portillo, El Urraco, Lomitas, Agua Sarca and la Veguita. In this region, the poverty is extreme so the deworming program (albendazole) and the dispensation of water filters (Sawyer) is critical.

The day ended with a magnificent cloudburst, lasting for several hours. Hot, humid and muddy.

Day 4, June 23, 2016:

Back to Lomitas for more punishment. The clinic lines were steady with patients from aldeas Santa Maria, Carmelitas, La Esperanza and San Felix. Again, many patients, mass deworming, water filter dispensation. My team was spectacular, working with efficiency and purpose. Leha Byrd, of VCU News, who has been present with us all week, has captured hours of interviews, narratives and footage, for an upcoming feature.

Day 5, June 24, 2016:

Back in La Hicaca for a full day of clinic. Patients were from aldeas Chorro Viento, La Culata, El Cerro and La Vega. The Ministry of Health was present with 2 local dentists to set up a dental clinic for today and tomorrow. Mass dental extractions of rotten teeth were in order. The Honduran television station, HNH, captured footage and some interviews for a news report.

Day 6, June 25, 2016:

Last day of clinic with patients from aldea La Lima. Plenty of cases were seem on the last day. This was followed by a brief ceremony for the brigade and a parting photo.

We headed down the mountain, back to Olanchito, for an evening of rest and relaxation. It has been a long yet productive week with 400+ adult patients and 400 + pediatric patients seen. Mass deworming was completed, hundreds of children were treated for head lice, 138 pap smear examinations were done and the exchange of water filters was begun. Water chlorination of the cisterns remains in place to further improve water potability.

Back to San Pedro Sula on the 26^th of June and back to the USA on the 27^th.

Full program details are available on the GH2DP website. A feature press release and short documentary will be forthcoming the week on July 11 th on VCU News.

Adios, for now.

Dental extractions

Water filters for potable water

Blogging in the field

Leha Byrd of  VCU News doing an interview with FatherPedro

Morning in La Hicaca

Internal Medicine clinic

Consult schedule 2016

Fecal  parasite analysis quick summary- Dr. Ana Sanchez

Honduras-VCU Global Health 2016: Back in Country, Getting Started

Mosquito control poster- Ministry of Health

The June 2016 VCU Global Health and Health Disparities trip to rural, mountainous La 
Hicaca and environs is about to push off.

Highlights for the upcoming brigade include:

• Reassessment of chlorine water sanitation project efficacy for sustainable potable water
• Re-deployment of home water filters for improvement of water sanitation, as summarized here.
• Ongoing implementation of new indoor cookstoves for improved indoor air quality, as previously summarized here.
• Ongoing deworming and assessment of mass deworming efficacy, in collaboration with Dr. Ana Sanchez of Brock University, Ontario, Canada.
• Ongoing installation of latrines to scale, in collaboration with the Pico Bonito Foundation, to minimize open defecation and the transmission of soil transmitted helminths
• At the request of the local Ministry of Health, as part of the station based clinic process- targeted, formal educational messages will be delivered. This will include messages to prevent diarrheal illnesses, respiratory illnesses and mosquito,vector-borne diseases such as Dengue, Chikungunya and Zika virus.
• Ongoing cervical pap smear assessments in collaboration with local public health authorities
• For the first time, in collaboration with our colleagues from Brock University, we will formally assess and de-lice school aged children.

As always, plans are fluid and subject to the unexpected nature of things in Honduras. 

VCU News is with us this year, filming a short documentary.

Stay tuned

Vibrio vulnificus Infections- Two in One Week

It has been a busy several weeks on the VCU Infectious Diseases consult service. 

We have seen two Vibrio infections causing severe skin and soft tissue infections in gentlemen who enjoy crabbing and aquatic activities in the Rappahanock river. 

As novel as it may seem to some, Vibrio is endemic yet rare in this part of Virginia, as reported here by the Virginia Department of Health.

Virtually nothing is risk free and the environment, aquatic or otherwise, is teeming with potential pathogens. Lacerations and heavy alcohol use with associated liver disease, as in one of the recent cases,does not help to minimize risk of infection with Vibrio.

Despite what is written in the lay press, Vibrio is not a 'flesh eating bacteria.'

Off to Honduras this weekend where there will be less Vibrio and more scabies.

Audiophiles, Check This Out: The Rise and Fall of Tower Records

I am off my medical topic so please forgive me. Those who know me will understand.

Audiophiles, check out this cool documentary, All Things Must Pass: The Rise and Fall of Tower Records. From a radical new record store in California to mega chain worldwide, Tower Records conquered the world but failed to keep up with the times.  

From vinyl to CD to MP3 to Napster to iTunes, the music (r)evolution is covered in the narrative of Tower Records.

Ironically, vinyl is back!

No music, no life. 

Nullius in Verba!

The Royal Society circa early 1800's. Source: The Times UK

Nullius in verba!  Take nobody's word for it. The motto of the British Royal Society.

I came across this while reading a book on the ancient science of enlightenment titled Siddartha's Brain. 

Take nobody's word for it. Look for truth by observation and empiricism.

I  wish that we were more rigorous in the practice of medicine, specifically infectious diseases. In this paper, at least 50% of Infectious Diseases Society of America Guidelines are based on expert opinion.

So if I suggest a treatment and justify it by that's just the way we do it, be skeptical, don't take my word on it.

Pragmatic studies and why I like them!

I was just recently asked to review a paper for Infection Control and Hospital Epidemiology. This got me thinking again about methodology.

The epidemiology gold standard study remains the cluster randomized, prospective trial. But not all clinical questions can be answered this way. Of note, to assess the effectiveness of hand hygiene it would not be ethical to perform a randomized, prospective trial of hand hygiene versus no hand hygiene across a health system.

There is another limitation of clinical trials: they frequently do not represent real life conditions.

Clinical trials are overseen by a dedicated team, have motivated participants and have structured oversight  to ensure protocol fidelity. I have seen  several prospective, clinical trials fail to "take root" after the conclusion of the protocol, even if the results were beneficial.

Pragmatic studies, although not as methodologically sound, can test the implementation of an intervention in real life situations. It may not be as robust, but it does give a sense of both feasibility and impact. This is practical and applicable. It is also reproducible.

If more robust protocols cannot be implemented in the real world, then what is their real value?

Not Just a Cold. VCU Medicine Grand Rounds- Dr. De La Cruz, Viral Respiratory Pathogens and Transplant Recipients

Congratulations to Dr. Oveimar De La Cruz of the VCU Infectious Diseases Division on an excellent internal medicine grand rounds on respiratory viruses in transplant recipients.

The lecture was informative and entertaining and covered the impact of viral respiratory pathogens (Influenza, RSV, Parainfluenza etc) on inflammatory pathogenesis, bronchiloitis obliterans pneumonia, bacterial and fungal co-infections, graft dysfunction and mortality.

Expect a published, invited review article on the topic in the next 12 months.

Not just a cold.